Senior Health Virtual RN

7 days ago


Somerville, Massachusetts, United States Mass General Brigham Full time
Job Title: Senior Clinical Quality Assurance Nurse Auditor

Mass General Brigham Health Plan is seeking a highly skilled Registered Nurse to join our team as a Senior Clinical Quality Assurance Nurse Auditor. This role is responsible for coordinating clinical quality assurance activities, including training and auditing materials, and performing audits to evaluate individual compliance with clinical processes and regulatory requirements.

Key Responsibilities:
  • Coordinate clinical quality assurance activities, including training and auditing materials
  • Perform audits to evaluate individual compliance with clinical processes and regulatory requirements
  • Work closely with the Clinical Quality Assurance & HEDIS Manager to monitor, maintain, and support the clinical department
  • Participate in departmental and organizational project teams and play a critical role in project implementation
  • Develop written summaries of specific key areas of training required for clinical staff based on audit results
  • Monitor staff adherence to designated NCQA UM, NCQA Complex Care Management (CCM), Quality Improvement (QI) and other standards
  • Communicate recommendations for operational changes based on survey findings to Quality and Clinical leadership
Requirements:
  • Registered Nurse with 5-10 years of clinical experience in a healthcare setting
  • Quality Assurance auditing experience a plus
  • NCQA experience preferred
  • Complex Care Management experience preferred
  • Utilization Management (InterQual) experience preferred
  • Excellent planning, coordination, and facilitation skills
  • Ability to translate and communicate complex topics in a variety of forums
About Us:

Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are on the forefront of transformation with one of the world's leading integrated healthcare systems. We are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage.

Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a consciously inclusive environment where diversity is celebrated. We are pleased to offer competitive salaries, and a benefits package with flexible work options, career growth opportunities, and much more.



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